Provider Demographics
NPI:1235672973
Name:KELCH-COHEN, AMY N (LCPC, CADC, CPT,EMDR)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:N
Last Name:KELCH-COHEN
Suffix:
Gender:F
Credentials:LCPC, CADC, CPT,EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-6913
Mailing Address - Country:US
Mailing Address - Phone:309-472-5283
Mailing Address - Fax:
Practice Address - Street 1:8801 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1635
Practice Address - Country:US
Practice Address - Phone:309-676-0538
Practice Address - Fax:309-214-0096
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178,012348101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178.012348OtherLICENSE